Please urgently tell your MP to oppose NHS Slash and Trash Bill on 14th July

The second reading for the Health and Care Bill (aka NHS Slash and Trash Bill) is on Wednesday 14th July. This is only a few days after its publication and it’s not possible that MPs have had a chance to get their heads round it.

Please will you ask your MP to oppose it at the second reading on Wednesday?

Below is the email that the Chair of Calderdale and Kirklees 999 Call for the NHS has sent Craig Whittaker. You’re welcome to send it to your MP too, amended as you see fit. It’s downloadable as a .doc file.

Here is the template email to download

(The full email is also given below.)

Why your MP needs to stop the Health and Care Bill

This BIll to seal  the imposition on the NHS of the USA’s cost-cutting managed/accountable care system has been on the horizon for years.

It is a particularly deceitful piece of legislation. Although it has been touted at every turn as intended to put Integrated Care Systems on a statutory basis, the Bill disguises its purpose by barely mentioning them.

Over the past 7 years, Calderdale and Kirklees 999 Call for the NHS have steadfastly opposed all the steps taken by successive governments to turn the NHS into a version of this system, from its introduction in the 2014-19 Five Year Forward View and then the establishment of Sustainability and Transformation Plans/Partnerships and their successors, the Integrated Care Systems.

This is because Integrated Care Systems are designed to turn the NHS from a comprehensive service for all, free at the point of need, into a highly restricted service where patients’ access is no longer on the basis of clinical need, but on the basis of actuarial decisions. Leaving increasing numbers of people without access to NHS treatments and care.  While skilled, highly qualified clinicians are replaced by less qualified and skilled staff and their clinical judgement is limited because – with withdrawal of routine NHS funding for more and more treatments and diagnostics –  commissioners now have the power to decide whether clinicians can provide treatments their patients need.

The new integrated care models are a direct threat to our own NHS in Calderdale and Kirklees – the Calderdale and Huddersfield hospital cuts and centralisation that we are still fighting mean hospital services we  rely on are being replaced by ‘care closer to home’ services that have consistently failed to show any evidence of their effectiveness in terms of outcomes for patients, and that were strongly criticised by the Yorkshire and Humber Clinical Senate.

Please email your MP before 14th July!

You need to include your postal address and postcode because MPs will only deal with correspondence from their own constituents. You can find who your MP is, and their contact details here.

This is what the template email says

[Insert your own address and postcode]

12 July 2021

Dear [insert your own MP’s name]

I am writing to you to ask you to oppose the government’s Health and Care Bill which is due to have its Second Reading in Parliament on Wednesday 14 July 2021. 

There is now strong evidence [1] that the whole basis of the innovation and integration Health and Care Bill is misguided:  a recent systematic synthesis of evidence on the health impacts of collaboration between local health care and non-health care organizations concluded that

“In theory, collaboration between local health care and non-health care organizations might contribute to better population health. But we know little about which kinds of collaborations work, for whom, and in what contexts. The benefits of collaboration may be hard to deliver, hard to measure, and overestimated by policymakers.”

In addition to its likely futility, the Bill would cause considerable harms: 

An increase in the rationing of healthcare – there will be a specific limit on the amount of money given to each Integrated Care System (ICS) in England.[2] In order to cut costs, Integrated Care Systems will operate “new care models” imported from the USA’s accountable/managed care system where actuarial calculations are applied to clinical decisions, limiting patients’ access to so-called elective treatments to those that represent good value for money.

Integrated Care Provider/Alliance contracts, which pass the risk of overspending the fixed contract budget onto providers, “incentivise” this cherry picking of patients. At the same time, routine NHS funding has been removed from a growing number of elective treatments and diagnostics, so that Commissioners  that holding the purse strings, not clinicians, decide if a patient can access these services. Under the tight financial controls operated by Integrated Care Systems, I am worried that people will be forced to go without the treatment they need or they will end up having to pay for healthcare.

A postcode lottery – ICSs in England will each have to develop a plan for the health needs in their area.[3] There will be different plans for different areas, so I am concerned that the services that people will be able to access will vary depending on where they live. Divisions between wealthy and deprived areas have widened during the Covid-19 pandemic and there is nothing in the Bill to correct this.

Big business at the heart of NHS decision-making and the delivery of services – this will put taxpayers’ money in the pockets of shareholders, and it will mean private companies have even more say in how public money is spent in the future and which health services are provided in a local area (and which are not). Huge global companies on NHS England’s Health Systems Support Framework are already paid a lot of money to do the backroom work of setting up the systems needed to run the new models of Integrated Care required by Integrated Care System. As a result global corporations are already at the heart of NHS decision making and the Bill’s imposition of a “duty to integrate” means these companies will become entrenched in the NHS, remaking it in the image of their own systems developed for the US managed health care market.

In terms of private companies delivering services,  Virgin Care already sits on the Bath and North East Somerset, Swindon and Wiltshire (BSW) Integrated Care System Board and when @SaveCRH tweeted BSW ICS to ask if VIrgin and other private companies would also be on the new Statutory BSW Integrated Care Board, they said they hadn’t yet decided.

NHS bodies simply being allowed to award contracts for clinical care to private healthcare providers without considering other bids [4] – this risks seeing further privatisation and cronyism, the kind of which we have seen during the coronavirus pandemic as the government has handed billions of pounds of public money to private companies.

The government is spinning the Bill’s changes to NHS procurement – particularly its abolition of the competitive tendering requirement in s 75 of the 2012 Health and Social Care Act – as reducing privatisation and the associated costs of contracting. In fact the opposite is true. It will just make it easier to award contracts without scrutiny and the complex cumbersome forms of contracting for integrated services are already a nightmare.

Huge 10 year integrated services contracts already being awarded through the non-competitive light touch regime on the basis of, for example, shared dialogue, have  run into big problems.

For example, the failure to launch the 10 year, £440m alliance contract for North East Essex Integrated Community Services (NICS), awarded earlier this year, must surely cast doubt on the unwieldy procurement process for huge public-private NHS contracts.

Vulnerable patients being put at risk – the bill removes the requirement for social care needs assessments to be carried out by the relevant local authority before a patient is discharged from hospital [5]; this will leave families to pick up the pieces, and those without family at risk of isolation and lack of care.

The deregulation of NHS professions [6] – this would have serious implications for the quality of care, as well as the employment status, pay and terms and conditions of a range of NHS workers. I am also concerned that it will lead to the down-grading of roles. This concern was summed up well in a recent article by Prof. Kailash Chand, an Honorary Vice President of the British Medical Association, in which he wrote: ‘The core thrust of the new reforms is to deprofessionalise and down skill the practice of medicine in this country, so as to make staff more interchangeable, easier to fire, and services more biddable, and, above all, cheaper.’[7]

It is clear that NHS staff are exhausted as a result of dealing with the coronavirus pandemic. Sir David Nicholson, former Chief Executive of NHS England has warned that the government’s impending shake-up of the NHS could prompt a lot of staff who are already exhausted by Covid-19 to quit. [8] Furthermore, there are now more than five million people on England’s NHS waiting list. [9]

The government’s plans would clearly undermine the principles of the NHS on which we have all relied since 1948. 

Once again, I ask that you oppose this bill at Second Reading on Wednesday 14 July. 

Yours sincerely, 
[Your name]

1 https://doi.org/10.1186/s12889-021-10630-1
2 210140en.pdf (parliament.uk), p. 72 
3 Report template – NHSI website (england.nhs.uk) p. 12 
4 Health bill could see NHS contracts awarded without tender process | NHS | The Guardian  
5 210140en.pdf (parliament.uk), p. 36 
6 *210140en.pdf (parliament.uk), p. 37 
7 Prof Kailash Chand OBE FRCGP on Twitter: “This needs wide publicity…. We can’t afford to take our eye off this! https://t.co/cgSPkHudr7” / Twitter 
8 ‘A truly frightening backlog’: ex-NHS chief warns of delays in vital care | NHS | The Guardian
9 Number of people on England’s NHS waiting list tops 5m for first time | NHS | The Guardian  

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